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Catamenial Epilepsy

Homepage: EMNote.org ■ 🚩Membership: https://tinyurl.com/joinemnote 🚩ACLS Lecture: https://tinyurl.com/emnoteacls Catamenial Epilepsy Catamenial Epilepsy Catamenial epilepsy is a form of epilepsy in women where seizure frequency or severity increases due to hormonal fluctuations during the menstrual cycle. It manifests in three patterns perimenstrual, periovulatory, and luteal phase. Catamenial Epilepsy Estrogens promote seizures, while progesterone has anticonvulsant effects. Approximately one-third of women with epilepsy experience catamenial epilepsy, necessitating specialized care. Diagnosis Diagnosis involves tracking seizure patterns in relation to the menstrual cycle. Patients maintain a seizure diary for at least three months to note seizure timing and frequency alongside their menstrual cycle. Diagnosis Ovulation test kits and hormone level assessments help understand the relationship between seizures and hormonal changes. An EEG may be used to detect abnormal brain activity during seizures. Treatment There are no specific medications uniquely effective for catamenial epilepsy, but various treatments are available. Hormonal therapies, such as progesterone and medroxyprogesterone acetate, may reduce seizure frequency, especially during the luteal phase. Treatment Non-hormonal options include acetazolamide and clobazam, used intermittently around menstrual periods. Ganaxolone, a GABA-A receptor modulator, is under investigation as a potential treatment. More research is needed to establish the effectiveness of these therapies. Effectiveness of Progesterone Progesterone is often compared to other hormonal treatments like norethisterone. Studies show that progesterone's effectiveness in reducing seizure frequency is not significantly different from placebo in many cases. Effectiveness of Progesterone Evidence regarding progesterone's efficacy is of low to moderate certainty, with no significant differences in seizure outcomes across several trials. Norethisterone shows similar results, indicating a need for more robust research to determine the best hormonal treatment options. Side Effects of Progesterone Hormonal Effects: Common side effects include vaginal bleeding and breast tenderness. Central Nervous System Effects: Higher doses may cause depression, asthenia, and sedation. Side Effects of Progesterone Other Side Effects: Some patients report headaches and nausea, which may require discontinuation of treatment. Monitoring is essential to manage these side effects effectively. Conclusion Catamenial epilepsy is a significant condition affecting many women with epilepsy, linked to hormonal fluctuations during the menstrual cycle. Diagnosis relies on tracking seizure patterns and hormonal changes, while treatment options include hormonal and non-hormonal therapies. Conclusion Progesterone and other hormonal treatments show limited effectiveness, with potential side effects requiring careful management. Further research is needed to improve treatment outcomes for women with catamenial epilepsy.